Organs from overdose-death donors a viable option for transplant

Last Updated: 2018-04-16

By Marilynn Larkin

NEW YORK (Reuters Health) - Transplantation with overdose-death donor (ODD) organs has increased dramatically in the U.S., with equivalent outcomes to non-ODD organs, and therefore these organs should not be routinely discarded, researchers in Maryland say.

"Most Americans know that the U.S. faces an epidemic of deaths due to drug overdose, and many are also aware that there is a critical shortage of organs available for transplant," Dr. Christine Durand of Johns Hopkins University School of Medicine in Baltimore told Reuters Health.

"Perhaps less widely known is that today, more than one in every 10 deceased organ donors died from a drug overdose," she said by email.

"Patients who received transplants from these donors had excellent outcomes; patient survival and organ function were similar to cases when donors died due to trauma, and similar or better than cases when the donor died due to medical causes of death like heart attack or stroke," she added.

Dr. Durand and colleagues examined data from January 2000 to September 2017 on 138,565 deceased donors and 337,934 transplant recipients at 297 transplant centers in the U.S.

After determining cause of death - ODD, trauma-death donor (TDD) or medical-death donor (MDD) - they compared patient and graft survival and organ discard (organ recovered, but not transplanted) among the donor types.

As reported in Annals of Internal Medicine, online April 16, they identified 7,313 ODDs and 19,897 ODD transplants (10,347 kidneys; 5,707 livers; 2,471 hearts; and 1,372 lungs).

The number of ODDs increased annually, from 66 in 2000 to 1,263 in 2016 and 915 in the first nine months of 2017 (1.1%, 12.7%, and 13.4% of the national pool, respectively).

ODDs were more likely to be white (85.1%), ages 21 to 40 (66.3%), infected with hepatitis C virus (18.3%), and increased-infectious risk donors (IRDs; 56.4%), i.e., donors whose behaviors could increase the risk for HIV or hepatitis B or C infection.

Standardized five-year patient survival was similar for ODD organ recipients compared with TDD organ recipients (standardized risk differences ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival).

Standardized five-year graft survival was also was similar between ODD and TDD grafts: little survival difference for kidneys and lungs, marginally lower (sRD, 3.2%) for livers, and marginally higher (sRD, 1.9%) for hearts.

Standardized five-year graft survival was similar for ODD and MDD livers (sRD -1.0%) and slightly higher for ODD versus MDD hearts (sRD 2.6%).

Standardized graft survival for lungs was similar across donor types.

The kidney discard rate was higher for ODDs than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for hepatitis C virus and IRD status attenuated the difference.

"The organ discard is likely related to two factors," Dr. Durand said: "1) the growing prevalence of hepatitis C among overdose death donors, now greater than 30%, and 2) ODDs being more likely labeled increased infectious risk donors (IRDs) due to behaviors such as injection drug use that may increase the risk of HIV or hepatitis."

"Considering the benefits of a lifesaving transplant, we believe the number of discarded organs from ODDs should be lower," Dr. Durand said. "With so many patients waiting for a transplant - 115,000 Americans as of April 2018 - it's important that we work hard to best use the organs for transplant that are available."

"IRD is an administrative label that continues to be been associated with lower acceptance rates among patients despite a significant survival benefit of an IRD organ transplant," she noted. "In my opinion, all patients should absolutely consent to consider IRD organs."

"The increasing number of ODD organs is not an ideal or sustainable solution to the national organ shortage," she acknowledged. "The current epidemic of deaths from overdose is a tragedy."

"It would also be tragic to continue to underutilize life-saving organs donated for transplant," she said. "We have an obligation to optimize the use of all organs donated. The donors, families, and patients waiting deserve our best effort to use every 'gift of life' we can."

Nephrologist Dr. Vasishta Tatpudi of NYU Langone Health in New York City said in an email to Reuters Health that the findings "allay prevailing concerns regarding clinical outcomes in recipients of ODD organs and may provide impetus for broader acceptance of these viable and otherwise lifesaving organs by transplant physicians and recipients alike."

SOURCE: https://bit.ly/2EQYpVT

Ann Intern Med 2018.